Voice Disorders

A voice disorder is when the voice has a problem with pitch, volume, tone, and other qualities. These problems occur when the vocal cords don't vibrate normally.

Your voice is the sound that air makes when it is forced out of your lungs and passes over your vocal cords. Vocal cords are the two folds of tissue inside your larynx, also called the voice box. The vibration of those cords is what produces speech.

In order to make normal speech, your vocal cords need to touch together smoothly inside your larynx. Anything that interferes with vocal cord movement or contact can cause a voice disorder. Many voice disorders can be cured with treatment when diagnosed early.

Signs and symptoms of a voice disorder

When people have a voice disorder, their voice may:

Have a quivering sound

Sound rough or harsh (hoarse)

Sound strained or choppy

Be weak, whispery, or breathy

Be too high or low or change in pitch

They may have tension or pain in their throat while speaking, or feel like their voice box is tired. They feel a "lump" in their throat when swallowing, or feel pain when they touch the outside of their throat.

Causes of a voice disorder

Voice disorders can be caused by many factors. In some cases, the cause of a voice disorder is not known. Possible causes can include:

Growths. In some cases, extra tissue may form on the vocal cords. This stops the cords from working normally. The growths can include fluid-filled sacs called cysts, wart-like lumps called papilloma, or callus-like bumps called nodules. There may be patches of damaged tissue called lesions, or areas of scar tissue. In some people, a band of tissue called a web can grow between the vocal cords. Other growths include a small area of chronic inflammation called a granuloma, and small blisters called polyps. Growths can have many causes, including illness, injury, cancer, and vocal abuse.

Inflammation and swelling. Lots of things can cause inflammation and swelling of the vocal cords. These include surgery, respiratory illness or allergies, GERD (acid reflux), some medications, exposure to certain chemicals, smoking, alcohol abuse, and vocal abuse.

Nerve problems. Certain medical conditions can affect the nerves that control the vocal cords. These can include multiple sclerosis, myasthenia gravis, Parkinson disease, ALS, and Huntington disease. Nerves can also be injured from surgery or chronic inflammation of the larynx (laryngitis).

Misuse of the voice. The vocal cords can be stressed by using too much tension when speaking. This can cause problems in the muscles in the throat, and affect the voice. Vocal abuse can also cause a voice disorder. Vocal abuse is anything that strains or harms the vocal cords. Examples of vocal abuse include too much talking, shouting, or coughing. Smoking and constant clearing of the throat is also vocal abuse. Vocal abuse can cause the vocal cords to develop calluses or blisters called nodes and polyps. These change how the voice sounds. In some cases, a vocal cord can rupture from vocal abuse. This causes the cord to bleed (hemorrhage), and can cause loss of voice. Vocal cord hemorrhage needs to be treated right away.

Examples of voice disorders

Laryngitis. Laryngitis is when your vocal cords swell. It makes the voice sound hoarse. Or you may not be able to speak. Acute laryngitis happens suddenly, often because of a virus in the upper respiratory tract. It often lasts just a few weeks. Treatment is to rest the voice and drink lots of fluids. Chronic laryngitis is when the swelling lasts for a long time. Common causes include a chronic cough, using inhalers for asthma, and GERD. Treatment of chronic laryngitis depends on the cause.

Vocal cord paresis or paralysis. The vocal cords can be paralyzed, or partially paralyzed (paresis). This can be caused by a viral infection that affects your vocal cord nerves, an injury to a nerve during surgery, stroke, or cancer. If one or both of your vocal cords are paralyzed in a nearly closed position, you may have noisy or difficult breathing. If they are paralyzed in an open position, you may have a weak, breathy voice. Some people will get better over time. In other cases, the paralysis is permanent. Surgery and voice therapy may help improve the voice.

Spasmodic dysphonia. This is a nerve problem that causes the vocal cords to spasm. It can make the voice sound tight, quivery, or jerky, hoarse, or groaning. At times, the voice may sound normal. Other times, the person may not be able to speak. Treatment may include speech therapy and injections of botulinum toxin to the vocal cords.

Diagnosing a voice disorder

If you have a voice change that lasts for a few weeks, your primary care provider may send you to see a throat specialist called an otolaryngologist. An otolaryngologist will ask you about your symptoms and how long you've had them. He or she may examine your vocal cords and your larynx using certain tests. These may include:

Laryngoscopy. This lets otolaryngologist view the throat. With indirect laryngoscopy, the health care provider holds a small mirror at the back of the throat and shines a light on it. With fiberoptic laryngoscopy, a thin, lighted scope called a laryngoscope is used. The scope is put through your nose down into your throat, or directly down into your throat.

Laryngeal electromyography, or EMG. This test measures electrical activity in the muscles of the throat. A thin needle is put into some of the neck muscles while electrodes send signals from the muscles to a computer. This can show nerve problems in the throat.

Stroboscopy. This test uses a strobe light and a video camera to see how the vocal cords are vibrating during speech.

Imaging tests. X-rays and MRI can show growths or other tissue problems in the throat.

Treating a voice disorder

Treatment for a voice disorder depends on what's causing it. Treatment may include:

Lifestyle changes. Some lifestyle changes may help reduce or stop symptoms. These can include not yelling or speaking loudly, and resting your voice regularly if you speak or sing a lot. Exercises to relax the vocal cords and muscles around them can help in some cases.

Speech therapy. Working with a speech-language pathologist can help with certain voice disorders. Therapy may include exercises and changes in speaking behaviors.

Medications. Some voice disorders are caused by a problem that can be treated with medication. For example, antacid medication may be used for GERD, or hormone therapy for problems with thyroid or female hormones.

Injections. Muscle spasms in the throat can be treated with injection of botulinum toxin. In some cases, fat or other fillers can be injected into the vocal cords. This can help them close better.

Surgery. Some tissue growths can be removed. If growths are caused by cancer, other treatment, such as radiation therapy, may be needed.